Miliary tuberculosis in association with chronic cutaneous tuberculosis

A case of miliary tuberculosis associated with two different forms of cutaneous tuberculosis and a negative Heaf tuberculin test is reported. The value of skin biopsy and culture in helping to establish an early diagnosis is discussed. The unusual finding of a negative Heaf tuberculin test is commented upon.     

A clinical and histopathological profile of patients with cutaneous tuberculosis

Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. The commonest site of involvement was limbs seen in 50% patients followed by neck seen in 25% patients, face in 15%, and trunk in 10% patients. Maximum percentage of patients (55%) had duration of cutaneous tuberculosis between 6-12 months followed by 35% between 13-24 months, 5% had duration of cutaneous tuberculosis less than 6 months, and the rest 5% had duration more than 24 months. The commonest histopathological feature in our study was tuberculoid granuloma with epitheloid cell and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 15% patients and AFB bacilli were seen in 5% patients.     

16例皮肤结核分离菌株药敏试验分析

目的 探讨结核分枝杆菌皮肤感染的耐药情况,为该病的临床治疗提供参考依据.方法 分离培养的16株分枝杆菌经生化和分子生物学方法鉴定为结核分枝杆菌;采用国内公认的绝对浓度间接法分别检测16株结核分枝杆菌对异烟肼、链霉索、利福平和乙胺丁醇四种药物的耐药情况;对其中2株链霉素耐药临床株进行rpsL基因扩增和DNA测序.结果 16株结核分枝杆菌中,2株对链霉素耐药,对异烟肼、利福平和乙胺丁醇敏感;其余14株对利福平、异烟肼、乙胺丁醇和链霉素均敏感.2株链霉素耐药临床株中,1株rpsL基因43位密码子突变为AAG→AGG;另一株rpsL基凶54位密码子突变为CGC→AC.结论 近5年收治的结核分枝杆菌皮肤感染患者耐药率不高,以链霉素耐药为主.     

Incidence of skin cancer in 5356 patients following organ transplantation

BACKGROUND: Skin cancer following solid organ transplantation is an important cause of morbidity in long-term survivors. This risk is well known but imprecisely quantified. OBJECTIVES: We aimed to determine: (i) the skin cancer risks in transplant patients more precisely; (ii) whether the risk of malignant melanoma is altered; and (iii) whether the risk of epithelial cancers occurring at non-exposed sites is comparable with that seen in sun-exposed sites. METHODS: We linked a population-based cohort of 5356 patients who had received organ transplants in Sweden between 1970 and 1994 with the compulsory Swedish Cancer Registry, to identify all cancer cases except basal cell carcinomas, which are not registered. RESULTS: After a mean follow-up of 5.6 years post-transplantation, 172 of 5356 patients developed 325 non-melanoma skin cancers (excluding basal cell carcinomas) and six malignant melanomas. The relative risk of non-melanoma skin cancer was 108.6 [95% confidence interval (CI) 94.6-123.1] for men and 92.8 (95% CI 73.2-116.0) for women. The highest risks were noted for upper limbs, and the risk increased with time. No significant increase in malignant melanomas was noted: the relative risk was 1.6 (95% CI 0.5-3.7) for men and 0.5 (95% CI 0. 0-2.6) for women. Except for the lip, which is also sun-exposed, other epithelial sites did not show comparable increases in cancer risk. CONCLUSIONS: We conclude that organ transplant recipients are at a highly increased risk for non-melanoma skin cancer and must be closely followed throughout their lives. Cancer risk associated with transplantation is higher for sun-exposed than for non-sun-exposed epithelial tissues, even among populations living in regions with low solar insolation.     

Inoculation cutaneous tuberculosis

Two cases of inoculation cutaneous tuberculosis are presented. As commonly occurs, the diagnosis could not be confirmed bacteriologically due in the small numbers of organisms present However, both patients responded to antituberculosis chemotherapy.     

Sporotrichoid cutaneous tuberculosis

Three patients with sporotrichoid cutaneous tuberculosis have been described. Two were children of either sex with lesions of lupus vulgaris along the lower limb and one woman had scrofuloderma along the left arm. Culture for Mycobacteria being negative, the diagnosis was based on the clinical picture, positive tuberculin test, granulomatous dermatitis on histopathology and regression with anti-tubercular DOTS therapy. Sporotrichoid presentation of scrofuloderma appeared to simulate sporotrichosis more than sporotrichoid lupus vulgaris. As seen from other reports and the present one, children and those just past adolescence have often been affected. Since sporotrichoid pattern is known to be usually associated with the less pathogenic atypical or non-tuberculous mycobacteria, it is speculated that the good lymphatic drainage and proneness to trauma that go with the high physical activity in these age groups may rarely result in this clinical presentation of cutaneous tuberculosis.     

Management of cutaneous tuberculosis

ABSTRACT:   Cutaneous tuberculosis (TB) is an extrapulmonary form of tuberculosis, which may be classified based on the immunologic state of the host. Chemotherapy still remains the treatment of choice. The management of cutaneous TB follows the same guidelines as that of TB of other organs, which can be treated with a short course four-agent chemotherapeutic regimen given for 2 months followed by a two-drug regimen for the next 4 months. This chapter highlights current treatment recommendations for cutaneous TB. The important factors to consider in the choice of optimal treatment includes the type of cutaneous involvement, stage of the disease, level of immunity, and general condition of the patient. The highest priority in any cutaneous TB control program is the proper, accurate, and rapid detection of cases and the availability of chemotherapy to all tuberculosis patients until cure. Contact tracing is also an important component of efficient tuberculosis control.     

Immunohistopathological spectrum in cutaneous tuberculosis

Granulomas of lupus vulgaris were characterized by a raised CD4⁺/CD8⁺ ratio, while in scrofuloderma this was significantly decreased. Tuberculosis verrucosa cutis showed intermediate changes. These immunological variations suggest that cutaneous tuberculosis forms a spectrum with strong cell-mediated immunity seen in lupus vulgaris, and weaker cell-mediated responses in scrofuloderma; tuberculosis verrucosa cutis is intermediate between the two.     

皮肤结核的实验室检查

皮肤结核的临床表现缺乏特异性,传统的检查方法操作复杂、耗时长、敏感性和特异性差,容易造成漏疹和误诊.近年来,皮肤结核实验室检查有了新的进展,其中以PCR为基础的核酸扩增技术及环介导等温扩增法,能够快速、特异、敏感地进行分子诊断.酶联免疫斑点技术可代替纯化蛋白衍生物试验,为早期诊断结核潜伏感染提供新的方向.针吸细胞学检查结合抗酸染色或免疫组化能早期诊断并减少活检带来的创伤.BACTEC技术可以对分枝杆菌进行快速自动化分析和药敏试验.这些新的检测技术极大地提高皮肤结核的诊断水平.     

7例皮肤结核分离菌株药敏试验及利福平、异烟肼耐药基因突变情况分析

目的 探讨皮肤结核中结核分枝杆菌耐药及rpoB、katG耐药相关基因的突变情况。方法 从皮肤结核患者皮损或分泌物中分离、鉴定出7株结核分枝杆菌,采用比例法的间接法分别检测7株结核分枝杆菌对利福平、异烟肼、链霉素和乙胺丁醇四种一线抗结核药物的耐药情况,并对利福平耐药基因rpoB和异烟肼耐药基因katG进行PCR扩增和DNA测序。结果 7株结核分枝杆菌中,6株对利福平、异烟肼、链霉素和乙胺丁醇均敏感,1株对利福平、异烟肼和乙胺丁醇同时耐药。7株结核分枝杆菌均扩增出rpoB和katG基因条带。DNA测序结果显示,临床耐多药菌株rpoB基因531位密码子由TCG突变为TTG,katG基因315位密码子由AGC突变为ACC;其余6株药物敏感株均未发现上述基因突变。结论 皮肤结核中已分离出耐多药菌株,耐多药菌株的形成可能与治疗不当相关。     

Incidence of primary cutaneous T-cell lymphoma in Norway

Background  Studies from different countries have reported an increased incidence of primary cutaneous lymphomas over the last decades.
Objectives  To estimate the incidence rates of primary cutaneous T-cell lymphoma (CTCL) and mycosis fungoides (MF)/Sézary syndrome (SS) in Norway, and to compare these rates with those reported from other countries.
Methods  Data from the Cancer Registry of Norway on non-Hodgkin lymphomas during the period 1980–2003 were analysed.
Results  In total, 337 cases of CTCL were reported to the Cancer Registry during the study period, of which 262 cases were classified as MF/SS. The incidence rate of CTCL increased significantly ( P _trend < 0·001) from 0·16 (95% confidence interval, CI 0·11–0·20) per 100 000 person-years in 1980–84 to 0·29 (95% CI 0·22–0·36) per 100 000 person-years in 2000–2003. The incidence of MF/SS also increased during the same period ( P _trend = 0·05) from 0·15 (95% CI 0·10–0·19) per 100 000 person-years to 0·18 (95% CI 0·13–0·24) per 100 000 person-years.
Conclusions  The incidence of both CTCL and MF/SS increased in Norway during the period 1980–2003.